Minutes of the Croydon Health Services NHS Trust Annual General Meeting held on Monday 18 September 2023
Minutes of the Croydon Health Services NHS Trust Annual General Meeting held on Monday, 18 September 2023
1 Welcome and Introductions from Chair Yemisi Gibbons
Yemisi Gibbons, the Trust Chair, welcomed attendees to the meeting. She noted that she had never worked in an organisation with such a strong sense of community. She stated that more than two-thirds of the staff lived and worked in the borough, which made the organisation unique as they were often caring for close families and friends. However, she also acknowledged that the NHS had faced numerous unprecedented pressures, and like all NHS Trusts, they needed to listen to the people in their care and learn from their experiences, views, and suggestions.
The Chair emphasised the need to involve staff in finding the right solutions to challenges by embedding an open and supportive organisational culture. She highlighted that staff should feel empowered to raise concerns, be taken seriously, and be able to make the changes they want to see to benefit patients and other healthcare workers.
The Annual General Meeting provided an opportunity to hear how the Trust tackled some of those challenges and progressed towards achieving its ambitions for excellent health and care for all. The Trust had made a significant impact despite its relatively small size. Croydon was a trailblazer in integration, breaking down barriers between health and care teams to improve the health of the population. The Trust had opened a hospital within a hospital after the first wave of the pandemic to care for patients needing planned surgery and treatments, which became the blueprint for COVID recovery across the NHS. Over 32,000 patients have been treated since opening the Elective centre, including over 3,500 patients referred to Croydon from other Trusts to tackle the backlog.
The Trust was among the first to administer the COVID-19 vaccine, with more than ¾ of a million vaccines to date supported by the tireless work of GPs, pharmacists, and local vaccination teams. The Trust had one of the most diverse workforce profiles in the capital, reflecting the diverse communities they care for. The Trust cared for nearly 200,000 people needing urgent and emergency care last year, which was 5% less than the previous year but included an 11% increase in blue light ambulances, making Croydon one of the busiest A&Es in London.
In their specialist community teams covering every corner of the borough, the Trust cared for more than 80,000 people from the comfort of their own homes or in nearby clinics, including 2400 District nursing referrals and approximately 700 rapid response visits every month to care for people who needed extra support at home.
Despite the stark financial challenges facing the NHS, the Trust continued to invest in its services, with multi-million-pound redevelopments of its facilities. This includes opening the new Rainbow Children’s unit and the redevelopment of Croydon's intensive treatment unit, which would open later this year.
Next the Chair moved to the formal part of the agenda.
Formal Acceptance of Minutes from the 2022 Annual General Meeting
The minutes of the last meeting held on 21 September 2022 were approved as written.
Approval of the Annual Report and Accounts and the Quality Account
The Annual Reports and Accounts for 22/23, the Trust Quality Accounts for 22/23 and the Croydon Health Charity Annual Report and Accounts for 22/23 were brought to the AGM for formal acceptance. Reports and accounts had been published on the Trust website. The Chair confirmed that the Annual Reports and Accounts had all been formally accepted.
YG concluded by handing over to the Chief Executive Matthew Kershaw for a detailed review of the year.
Looking back on 2022/23
Matthew Kershaw, Chief Executive and Place-Based Leader for Health, presented a review of the past year. He acknowledged that 2022/23 had been exceptionally busy following the pandemic and financial challenges. The staff had responded remarkably well to the relentless pressure, and he expressed gratitude for their efforts.
The Prime Minister's visit to the Elective centre showcased the hard work invested in COVID-19 recovery. The Croydon Elective Centre exemplified the hospital's work and the "Healthy Communities Together" initiative aimed to support the community through collaborations between the Trust and the Voluntary sector.
Local partnerships were established across the borough to connect with the diverse population better. The Trust was recognised for its health award and listened to patient feedback to improve services, particularly in maternity care.
While there were positive developments in responsiveness and staff support, patient wait times remained a concern. The recent staff surveys highlighted the challenges faced in the healthcare environment, also from the staff perspective.
Balancing rising costs and maintaining quality had been and continued to be a focus, with a commitment to addressing inequalities in the local population. The Trust was accredited as a London Living Wage organisation, ensuring fair wages for all staff.
The Anchor Institution status reinforced the organisation's connection to the community and its commitment to employing local residents. The presentation concluded by introducing Andrew Brown and Ima Miah.
Working in partnership to make Croydon healthy
Andrew Brown, Chief Executive of BME Forum, and Ima Miah, CEO of the Asian Resource Centre, discussed community partnerships and health services.
Andrew highlighted the Croydon Health and Wellbeing Space, emphasising its accessibility and the positive impact it had in its first year of operation.
He spoke about the Personal Independence Coordinators, who worked with individuals in their homes to provide support and coaching, emphasising the programme's partnership with Mind in Croydon. He then also talked about the "Can you C Me Cancer Conference”, which focussed on raising awareness about cancer in the black community in the borough.
Andrew mentioned the partnership with the hospital during Black History Month and events that brought established individuals to engage with the Croydon community.
Ima Miah discussed the Community Care Hubs, which empower communities to support themselves and shared the progress made in developing these hubs.
She talked about the Care Home Connector Service, which connected care homes with external resources and support, highlighting the positive engagement with care homes and partnerships with local GP surgeries.
Ima concluded by emphasising the importance of community partnerships for positive change and success.
Improving Health & Reducing Health Inequalities
Hilary Williams, Interim Joint Director of Transformation and Commissioning, started her presentation by emphasising the importance of partnership in addressing health inequalities. As a testament to this, she highlighted the One Croydon Alliance Partnership, which brought together health services, local authorities, the Mental Health Trust, and the voluntary and community sectors to provide care and support, focusing on those in need.
The partnership's goals included simplifying services, breaking down organisational barriers, and promoting knowledge sharing among staff. They used a population management health approach to target interventions effectively.
Projects under the One Croydon Alliance included out-of-hospital care, integrated community networks, and engaging with vulnerable individuals. The integrated community care networks improved coordination and streamline care.
Hilary shared survey results showing that the integrated care network improved team collaboration and holistic care and empowered staff to provide person-centred care. The integrated care networks focussed on housing, access to information, and support, recognising their importance in health outcomes.
Hilary mentioned a mobile hub for mental health support, weight management services, community connectors, and the Healthy Communities Together programme. These initiatives aimed to empower the community and promote proactive health-seeking behaviours.
Additional efforts to address health inequalities include point-of-care testing for South Asian communities, cancer awareness programmes, and community-based conferences to harness local expertise.
Before concluding, Hilary emphasised the need for ongoing community engagement and partnership to address Croydon's unique health needs and vulnerabilities.
Performance Report
Lee McPhail, Chief Operating Officer for Croydon Health Services, discussed the challenges the service faced and the innovative approaches to address them.
He highlighted four key access targets: daily targets, elective planned care, referral to treatment, and diagnostics, emphasising the increased demand and the need for partnerships to address issues such as ambulance handover delays, mental health patient presentation, and lengthy inpatient stays.
He also discussed the impact of COVID-19 on diagnostic activities and cancer care, highlighting the continued efforts to recover the backlog and shorten waiting times for essential tests.
Lee then introduced transformations in services, including a new stroke unit with state-of-the-art facilities and, a rooftop garden for patients and staff, and a brand-new ITU unit set to open in December 2023. These developments aimed to improve patient care further and provide a 21st-century infrastructure.
He concluded by sharing videos featuring Miriam Margalese opening the stroke unit and a message from Miriam Buck, highlighting the positive impact these investments had on the organisation and the patients it served.
Sustainable Finances
Mike Sexton, Joint Chief Finance Officer of Croydon Health Services, provided an update on the Trust's sustainable finances. The key points covered were:
Financial Performance: The Trust's total income increased by 3% from £439.9 million in 2021/22 to £455.2 million in the current year. This increase was attributed to reduced COVID-19 vaccine activity and increased non-recurrent funding. The majority of funding comes from the NHS.
External Assurance: The external auditor, Grant Thornton, reviewed the 2022/23 annual accounts and provided opinions that the accounts presented a true and fair view and were properly prepared. The auditor also assessed the Trust's value for money in terms of financial sustainability, governance, and improving economy, efficiency, and effectiveness.
Expenditure: The Trust's revenue expenditure for 2022/23 amounted to £452 million. Approximately 67% of this expenditure went towards workforce costs, demonstrating a significant investment in staff. Other expenditures included drugs and medication, education and training, and maintaining the estate and facilities.
Capital Expenditure: The Trust allocated £32 million for capital expenditure in 2022/23. This included investments in medical devices, IT, roof repairs, fire doors, new lifts, the Rainbow Children's Unit, Patient Transfer Hub facility, ITU, Purley War Memorial Hospital, and New Addington Community Diagnostic Centre (CDC). There were also ongoing efforts to decarbonise healthcare.
Future Finances: The NHS, including Croydon Health Services, faced challenges in making the most of reducing resources to deliver sustainable services. The Trust had set an ambitious plan for 2023/24, aiming to achieve breakeven by 2024/25. This plan included £27 million in recurrent savings, £6.4 million from the elective recovery fund, and a focus on treating more patients.
Key Issues: Challenges for the Trust in 2023/24 included high demand for emergency care, the impact of industrial action on elective care, increasing inflation rates, and the need to achieve a challenging savings programme. Collaboration with the South West London Integrated Care System (ICB) and the local authority were essential to ensuring the sustainability of the Croydon health and care system.
Charitable Initiatives: The Croydon Health Charity had distributed a million pounds in 2022/23 for various initiatives, including the "Power of Play" appeal, engagement events for BAME maternity service users, investments in the Paediatric Integrated Unit, staff welfare, medical equipment, research, education, bereavement and reflective areas.
Mike also highlighted the "Little Breaths" appeal for children's ventilators and thanked the public for their support.
Providing High-Quality Care
Mary Dehinbo, the Director of Midwifery, provided an update on various aspects of healthcare:
Home-Based Care: Mary Dehinbo highlighted that healthcare extends beyond hospitals to homes and clinics across Croydon. Some key statistics included a 27% increase in "crisis response" home visits, 2,409 referrals to district nursing every month, and 87% of patients cared for at home within two hours of referral. Adult community therapy appointments increased by 11%, and 1,555 homebound vaccinations were administered.
One Croydon LIFE: This initiative aimed to help older people regain their health and confidence after a hospital stay. It involved collaboration between social workers, community geriatricians, nurses, and therapists. Key statistics showed 31,743 patient contacts, 417 referrals per month, and 3,201 packages of care in 2022/23, with 30% of residents reporting improved health and well-being within a year of referral.
Patient Safety: Care teams worked tirelessly to keep patients safe despite challenges such as COVID-19 and a challenging winter. Key points included continuously managing COVID-19 cases (albeit lower compared to the previous year), managing C. Diff cases and implementing additional safety measures, and looking after an increase in flu cases after easing COVID restrictions.
Raising Concerns: Mary emphasised the importance of staff feeling confident when raising concerns, and 83 concerns were raised to the Freedom to Speak Up Guardians, with 30% related to patient safety.
Patient-led assessments of the care environment praised the hospital's cleanliness, food quality, and care for people with dementia or disability.
The 2022 annual inpatient survey results were discussed, highlighting both positive and challenging aspects. While the number of patients willing to wait for a hospital bed decreased, more patients felt involved in decisions about their care and treatment.
Maternity Care: Croydon's maternity care received a 'Good' rating on every Care Quality Commission (CQC) measure. Key data included the number of babies born in the hospital, the CQC's inspection results, and areas of improvement. High vacancy and turnover rates in maternity were addressed with a new Recruitment Retention Strategy.
The presentation concluded with a story from a service user, Lintu, who shared her positive experience with the care she received. A video of Lintu's story was played.
Questions & Answers session:
A member of the public inquired about cancer screening, particularly regarding the notion that early-stage cancers were sometimes missed in black individuals during image tests.
Answer: Subhro Banerjee (Medical Director) clarified that the issue was not about one's ethnicity but rather body composition. People with very low body fat, which was often the case for lean and athletic black individuals, may face challenges with CT scans. Clinical teams may consider alternative imaging modalities in such cases.
Another member of the public asked what Croydon Health Services (CHS) was looking for to gain from voluntary organisations when forming partnership.
Answer: Matthew Kershaw mentioned that CHS looked for a commitment to collaboration, a willingness to work on common services, and a general desire to work as a community group.
An online question was also addressed, which revolved around proactive and preventative care in the community and partnerships.
Answer: Lee McPhail highlighted the need for adaptability and openness to different approaches to care delivery, especially during busy periods in the hospital. The focus was on considering clinical models that respond to the evolving needs of the healthcare system. Additionally, there was an emphasis on supporting self-management and helping patients transition to the community with the assistance of community groups.
Supporting our staff
Simon Haben, the Chief People Officer, discussed the importance of supporting and valuing the staff at the Trust. He provided key insights and data regarding staff engagement and well-being, including:
High Staff Engagement: Approximately 89% of the staff expressed that their work positively affects patients and service users. Additionally, many staff members looked forward to coming to work at Croydon compared to many other Trusts, indicating their commitment and dedication.
Challenges and Harassment: Around one-third of the staff reported experiencing some form of harassment, bullying, or abuse from patients, which is a concerning issue. To address this, the Trust had initiated a Kindness campaign and was working on improving training and the management of the hospital's environment to reduce aggression levels.
Feedback and Communication: The Trust is revamping the Freedom to Speak Up process, making it more accessible and straightforward for staff to provide feedback. This process was being facilitated by an independent third-party organisation to ensure that staff can voice their concerns and suggestions.
Industrial Action Impact: The ongoing industrial action presented challenges for staff and patients alike, and the importance of acknowledging and addressing the difficulties it poses were highlighted.
In addition to the above, the Trust had been taking various measures to support its staff, with the following highlighted:
Workforce Race Equality: Progress had been made in ensuring more black and other ethnic staff had access to training opportunities. Over 1,500 staff members participated in non-mandatory training in the last year, compared to only a few hundred four years ago.
Recruitment Inclusion Specialist Roles: These roles have been relaunched to equip senior staff with the training and tools to challenge potential biases in recruitment processes, particularly at the senior levels of the organisation.
Compassionate Leave Programme: This programme was introduced to reflect the Trust's core value of compassion and encourage staff to apply it to their work.
Apprenticeships: The Trust had tripled the number of apprenticeships, contributing to the professional development and growth of staff.
To improve staff well-being, initiatives such as Employee Appreciation Day, Croydon Stars, and other planned activities had been introduced. Staff Networks played a crucial role in enhancing the organisation's culture and had been revamped to support staff better. James Walkden, was introduced to the attendees.
IN FOCUS – Staff Networks LGBTQIA+
James Walkden, the Workforce Information Assistant and Network Co-Chair, shared updates on the LGBTQIA+ Staff Network, which had seen positive developments:
The network was relaunched earlier in the year under new Chair David Burgess, focusing on hearing members' views and ideas for the network’s direction. The first Croydon Health Services Pride Event occurred in June, with significant turnout and activities to raise awareness.
The network had over 80 members, emphasising strong LGBTQIA+ representation at the Trust. The network introduced the Safe Space badge scheme to signify support for LGBTQIA+ issues, with over 200 sign-ups. Educational materials were developed to promote understanding of LGBTQIA+ issues.
The Trust aimed to create an inclusive environment where staff, patients, and visitors felt safe to be themselves, although more work was needed to reinforce this sense of safety. The Trust continued to promote diversity and inclusion, and James expressed gratitude for the opportunity to discuss these issues.
Developing our leadership
Subhro Banerjee, the Medical Director, addressed the significant pressures facing the NHS, highlighting the Trust's response. The Trust navigated challenges associated with the winter season, the pandemic, and industrial action.
A newly established directorate, the Integrated Community Older People Rehabilitation & Specialist Services Directorate (ICORS), focused on community care, aligning with the goal of integration.
Innovative initiatives, such as HIV opt-out testing, had been launched, and Subhro highlighted that the Trust had received accolades for these efforts.
Remote monitoring and early discharge approaches aimed to provide better care for patients, while collaboration with other health sectors, including the Integrated Care System,was key to improving patient outcomes.
Subro discussed the Acute Provider Collaborative, which included CHS, St Georges, Epsom & St Helier’s hospitals working together to improve care quality.
Innovations included creating surgical hubs, a patient portal, and community diagnostic centres. He highlighted that strong clinical leadership was essential for implementing these changes.
Subhro also noted key personnel changes within the Trust during the year:
· Elaine Clancy had left the role of Chief Nurse, and Nicola Shopland stepped in as Interim Chief Nurse;
· Neil Goulbourne moved on from his role as Director of Strategy, Planning, and Performance;
· Hilary Williams succeeded Rachel Flagg as Director of Transformation and Commissioning, and Simon Haben joined as the new Chief People Officer.
At the beginning of 2023, the Trust had welcomed Yemisi Gibbons as the new Chair, in addition to a few changes of the Non-Executive Directors, with Dawn Reed and Steve Corbishley leaving the Trust, and Stephen Dilworth joining.
Furthermore, Steve Garside had joined as the new Director of Corporate Governance.
Subhro concluded by saying that the Trust remained committed to its mission and values amidst the evolving landscape of the NHS.
Matthew Kershaw Closing
Matthew Kershaw advised that over the past few months, CHS had developed and published the first five-year strategy update for Croydon Health Services, and he emphasised the need for an integrated approach to healthcare across Croydon. The strategy focuses on providing excellent care to patients and helping them lead healthy lives.
Matthew acknowledged the impact of industrial strikes on the Trust's activities, with approximately 7,000 procedures and appointments cancelled. He highlighted the challenge of rescheduling these appointments while maintaining essential emergency services.
A member of the audience expressed concerns about the impact on patients due to the industrial action and inquired whether staff who were on strike and subsequently work overtime received extra pay. Matthew clarified that staff who were striking did not receive extra pay. The priority was to provide safe emergency care to patients.
He addressed issues related to third-party partners and the need for efficiency in services such as patient transport, pharmacy services, and medication supply.
An online question inquired about considering lifestyle medicine and preventative care, particularly plant-based health professionals.
Answer: Matthew Kershaw mentioned that while there may be opportunities and developments in this area, it is not actively pursued at the moment.
Closing remarks
Yemisi Gibbons concluded the meeting by expressing gratitude to the dedicated staff, partners, and stakeholders who contribute to the success of Croydon NHS Trust. She emphasised the need for continuous adaptation, innovation, and a commitment to excellence in healthcare.